Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden.
Department of Surgery, University Cancer Center Leiden | The Hague, The Hague.
J Natl Compr Canc Netw. 2019 Jul 1;17(7):821-828. doi: 10.6004/jnccn.2018.7282.
Previous studies showing higher mortality after elective surgery performed on a Friday were based on administrative data, known for insufficient case-mix adjustment. The goal of this study was to investigate the risk of adverse events for patients with colon and rectal cancer by day of elective surgery using clinical data from the Dutch ColoRectal Audit.
Prospectively collected data from the 2012-2015 Dutch ColoRectal Audit (n=36,616) were used to examine differences in mortality, severe complications, and failure to rescue by day of elective surgery (Monday through Friday). Monday was used as a reference, analyses were stratified for colon and rectal cancer, and case-mix adjustments were made for previously identified variables.
For both colon and rectal cancer, crude mortality, severe complications, and failure-to-rescue rates varied by day of elective surgery. After case-mix adjustment, lower severe complication risk was found for rectal cancer surgery performed on a Friday (odds ratio, 0.84; 95% CI, 0.72-0.97) versus Monday. No significant differences were found for colon cancer surgery performed on different weekdays.
No weekday effect was found for elective colon and rectal cancer surgery in the Netherlands. Lower severe complication risk for elective rectal cancer surgery performed on a Friday may be caused by patient selection.
先前的研究表明，在周五进行择期手术的患者死亡率更高，这些研究基于行政数据，这些数据在病例组合调整方面存在不足。本研究的目的是使用荷兰结直肠审计的临床数据，通过择期手术的日期来调查结肠癌和直肠癌患者发生不良事件的风险。
前瞻性收集 2012-2015 年荷兰结直肠审计（n=36616）的数据，以检查择期手术日（周一至周五）死亡率、严重并发症和抢救失败的差异。以周一作为参照，对结肠癌和直肠癌进行分层分析，并对之前确定的变量进行病例组合调整。
对于结肠癌和直肠癌，择期手术日的死亡率、严重并发症和抢救失败率存在差异。经过病例组合调整后，与周一相比，周五行直肠癌手术的严重并发症风险较低（比值比，0.84；95%置信区间，0.72-0.97）。对于不同的工作日行结肠癌手术，未发现显著差异。
在荷兰，择期结肠癌和直肠癌手术不存在工作日效应。周五行择期直肠癌手术的严重并发症风险较低可能是由于患者选择。
